State attorney general sues mental health center for fraudulent claims

Tuesday

Jan 9, 2018 at 2:39 PMJan 10, 2018 at 1:40 PM

State Attorney General Maura Healey is suing South Bay Mental Health Center, Inc., with offices in Plymouth, Weymouth and Brockton, to recover what she claims are fraudulent payments from MassHealth, the state’s Medicaid program.. Healey claims the mental health center fraudulently billed MassHealth for services provided by unlicensed, uncertified and unsupervised employees. This pattern violates MassHealth’s regulations on mental health care, the attorney general’s spokeswoman said in a written statement. The lawsuit names a number of employees at 17 South Bay clinics across the state who do not have degrees in social work, making them ineligible for licenses. Instead, they have degrees in other types of therapy or counseling, such as art therapy and school counseling, the spokeswoman said. While staff can be unlicensed under MassHealth regulations, there must be enough licensed staff to supervise those employees, and the clinics involved do not meet that requirement. Since August 2009, MassHealth has paid more than $123 million to South Bay for outpatient services. The attorney general’s office estimates that a significant amount of that money was based on fraudulent claims for services given to more than 30,000 MassHealth members. Exact amounts were not available. The investigation began in August 2015 when a former employee of South Bay Mental Health Center sued the company in the U.S. District Court of Massachusetts.

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